Updated: Feb 17
The New Digital Age of Mental Health & Psychotherapy
Author: Carol Yan
The digital world, and the Internet as a whole, has had a significant impact on almost all aspects of our lives, including the field of psychotherapy. This has fast become an area in which the influence of the Internet is growing rapidly. (Amichai-Hamburger et al., 2014)
Since the onset of the COVID-19 pandemic, online psychotherapy has become the go-to choice for many people for a variety of reasons. However, this has also brought about discussions and debates regarding the benefits, limitations and ethical points regarding this platform for psychotherapy, compared to more traditional face-to-face sessions.
What is online psychotherapy?
Dadd (2020) explains that the ever-growing term of Online Psychotherapy (or commonly known as Teletherapy or E-Therapy) is the use of an online medium to provide psychotherapy. In essence, it applies the same psychological principles as face-to-face therapy within an online format. Basically, it is psychotherapy from the convenience and safety of your home.
In contrast to in-person therapy, online therapy allows you to connect with a registered therapist or counselor using any device that has an internet connection, such as a computer, tablet, or smartphone.
There are many reasons people opt for online therapy over in-person therapy. Online Therapy may be just as effective, depending on the context of the client and their presenting complaint. Research shows that online therapy can be just as effective as in-person therapy for various mental health conditions.
Luo, Sanger, Singhal, et al. (2020) found online cognitive behavioral therapy (CBT) to be just as effective as in-person therapy in treating moderate depression. Another review by Andrews, Basu, Cuijpers , et al. (2018) found that online CBT was equally effective as a face-to-face treatment for panic disorder, social anxiety disorder, and generalized anxiety disorder. Online therapy is even shown to be effective in reducing problem gambling behaviors according to van der Maas, Shi, Elton-Marshall, et al. (2019).
This could also be the case for brain-based techniques such as Brainspotting, EMDR and BWRT, however there seems to be a gap here in this literature.
According to our personal experiences in working online using these techniques, having had experience in both settings - it seems to be as effective as in-person sessions, however further exploration into this specific field is required.
Online therapy also provides the opportunity for access to mental health treatment to people in rural or remote areas. Those who live in rural areas simply might not have access to any other form of mental health treatment because there are few or no mental health practices in their area.
Having to drive long distances and take significant time out of a busy schedule to seek in-person therapy can be a challenge for people who are seeking professional assistance.
If one has reliable internet access, online therapy gives relatively quick and easy access to treatment that might not have been readily available otherwise.
For instance, within the South African context this means that people living in remote areas or places, where there is usually no easy access to psychotherapy, can have access to psychotherapy through means of teletherapy.
It also provides a space for continuity as it assists clients who are already in a therapeutic process and do not want this process to stall when they travel for business or other reasons. (Ernst, 2017)
In addition, people who are unable to leave their home for various reasons, such as physical or mental illness, may find online therapy a useful alternative to traditional in-person space. We can see this being the case during the Covid pandemic where people who were unable to leave their home for various reasons, including one being a health risk - those who fell within the high risk category themselves or having a family member in this category. The online therapy platform was still able to provide a safe space to be held and supported.
Online therapy also provides accessibility to individuals who are disabled or housebound. Mobility can be a big challenge when it comes to accessing mental healthcare. A therapist practicing at their own home space, for example, may not be able to set up to accommodate clients of all abilities.
Baumel (2015) also mentioned that the internet has had a significant impact on mental health treatment and making it more approachable.
Online access makes it easier to overcome the stigma that has historically been attached to mental health issues. Teletherapy can be an important tool to help people learn more about mental health in a space where they feel comfortable, as all they need is a stable internet connection.
Even if someone feels like their mental well-being is strong or they feel in-control, online therapy can also provide a safe space to explore and be curious and simply experience this space, thus adding to their toolbox and becoming ‘psychologically stronger’ or ‘mentally fit’.
As much as we have discussed the benefits of Online Therapy, we must also note and discuss the limitations. E-therapy can be useful for a variety of situations, but not when it comes to people that require close and direct treatment or in-person intervention. (Christensen, Batterham, Calear, 2014)
Being mental health practitioners, we must also be aware of our limitations as psychotherapists when it comes to the online space and how effective or ineffective this space can be for each unique client.
For example, during crisis situations. Since online therapists are distant from the client, it can be difficult for them to respond quickly and effectively when a crisis happens. This needs to be kept in mind when working as an Online Therapist.
If a client is experiencing suicidal thoughts or has suffered a personal tragedy, it can be difficult or even impossible for the therapist to provide direct assistance. The online space may also not be appropriate for psychiatric cases.
Often, in cases of severe or complex symptoms, online therapy may not be recommended unless other in-person therapies or treatments are also involved in the holistic plan. In these ways, the scope of online therapy is limited.
In saying this, the very first session within the Online Psychotherapy space should also be used to evaluate whether the online platform would be the best option for the client sitting in front of you.
Another point that has been up for discussion is that Online Therapy eliminates geographic restraints, making the enforcement of legal and ethical codes difficult. Therapists can consult with clients from anywhere in the world, and many countries and states have different licensing or registration requirements and treatment guidelines.
In some cases, governing body guidelines are outdated and do not accurately reflect the infinite developments in technology as well as the need for online therapy which has increased significantly over the last couple of years. (Ernst, 2017)
This is still an ongoing discussion and debate in our profession. What are your thoughts on this as a mental healthcare professional?
To end off on this note - as it is with everything in the field of Psychology - it is always important to keep and trust our clinical judgement for each client we come across, be conscious of our limitations with what the online space can provide, and refer as and when needed for in-person sessions depending on each unique context and presenting complaint.